Combined Use of Chinese Medicine with Allogeneic Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia Patients

Objective:To determine the effect of combined treatment with Chinese medicine（CM） and allogeneic hematopoietic stem ceil transplantation（allo-HSCT） on patients with severe aplastic anemia（SAA）.Methods:Eleven patients were treated with CM plus ailo-HSCT.Nine patients received a conditioning regimen consisting of fludarabine（Flu）,anti-thymocyte globulin（pig ALG）,or anti-lymphocyte globulin（Rabbit ATG） and cyclophosphamide（CY）,and two patients received pig ALG and CY.All patients were treated with Kidney（Shen）-reinforcing,blood-activating,and stasis-removing（KBS） herbal preparation beginning at 1 week before transplantation and ending at 8 weeks after transplantation.Chimerism status was assessed by analyzing short tandem repeat（STR） polymorphisms.Results:All patients recovered hematopoietic function and none had graft failure.The median number of days required for the absolute neutrophil count（ANC） increased to >0.5× 10;/L was 15 days（12-22 days） and for spontaneous platelet recovery to >20×10;/L without post-transplantation transfusion was 17 days（15-27 days）.Nine patients were longterm survivors and achieved full donor chimerism.The overall cumulative incidence of acute graft versus host disease（GVHD） grades Ⅰ-Ⅱ and Ⅲ-Ⅳ was 18.2%（2/11） and 9.1%（1 /11）,respectively.The overall accumulated incidence of chronic GVHD was 27.3%and all patients had limited chronic GVHD.At a median follow-up time of 32 months（range:12-97 months）,9 patients were still alive.The estimated 5-year overall survival（OS） rate was 81.8%.The incidence of treatment-related mortality,2-year post-transplantation,was 18.2%.Two patients died from GVHD after transplantation.Conclusion:Treatment with the KBS formulation may reduce the rate of graft failure and treatmentrelated mortality and improve the rate of OS in SAA patients with allo-HSCT.